1/43. Pellet embolization to the right atrium following double shotgun injury.A 28-year-old man sustained two shotgun injuries of the left inguinal region from a distance of about 1.5 m by simultaneous discharge of both shells from a sawn-off double-barrelled 16-bore shotgun (diameter of the lead pellets, 4 mm). The first X-ray examination carried out soon after hospital admission showed a single embolized pellet near the right margin of the cardiac silhouette. Eight months later, the man committed suicide by drug intoxication. At autopsy, the embolized pellet was found embedded between the pectinate muscles of the right atrium. On the basis of the reported case and with reference to the pertinent literature, the paper points out the medico-legal aspects of venous bullet/pellet embolism and the risk of lead poisoning after shotgun injury.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
2/43. Pediatric scalp laceration repair complicated by skin staple migration.skin staples are ideal for pediatric scalp laceration closure because of their rapidity of placement and economy and ease of use. We report two cases of rotatory staple migration necessitating improvised removal techniques. Clinicians should be alert for this complication, which may result from a combination of staple design, local anatomic factors, superficial placement, and prolonged delay prior to removal.- - - - - - - - - - ranking = 13.765368976142keywords = closure (Clic here for more details about this article) |
3/43. Late traumatic intraocular lens extrusion after penetrating keratoplasty.BACKGROUND: Penetrating keratoplasty places a patient at risk for wound rupture from blunt trauma because the graft-host interface remains weakened for years after the surgery. Violent environments, contact sports, and strenuous activity put patients with compromised corneal structural integrity at high risk of traumatic injury. CASE REPORT: This case report presents a 42-year-old penetrating keratoplasty patient with a history of homelessness, polysubstance abuse, and domestic violence. This patient experienced a ruptured globe at the graft-host junction secondary to a direct blow by a fist, which extruded the intraocular lens from the eye. After emergency wound closure, the graft continued to degrade until bullous keratopathy developed. With little visual recovery potential for this graft, a Gunderson conjunctival flap procedure was implemented to decrease chronic ocular pain. CONCLUSIONS: After penetrating keratoplasty, patients should be periodically reminded of the susceptibility of the graft wound to injury from high-risk activity and violence. Constant use of protective eyewear should be recommended to corneal transplant recipients.- - - - - - - - - - ranking = 13.765368976142keywords = closure (Clic here for more details about this article) |
4/43. Late coil migration due to thrombolysis after successful implantation of a coil for persistent ductus arteriosus.Transcatheter coil occlusion of persistent ductus arteriosus (PDA) is now a widely accepted treatment for PDA. However, late complication might occur due to thrombolytic treatment during the interventional period. We discuss a case with late coil migration due to thrombolysis after successful implantation of a coil. It should be emphasized that early thrombus formation is important for successful closure of PDA shunt using coil.- - - - - - - - - - ranking = 13.765368976142keywords = closure (Clic here for more details about this article) |
5/43. Cranio-orbital missile wound and bullet migration. Case report.An unusual case of craniocerebral missile injury, with orbital roof perforation and spontaneous bullet migration into the maxillary sinus, is reported. emergency treatment consisted in wide craniectomy around the bullet entry point, blood and foreign bodies debridement. Subsequent procedures were necessary for abscess evacuation, transmaxillary bullet removal and later cranial vault reconstruction. Challenging aspects were the treatment of the infectious complications, following cerebrospinal fluid fistula through the wound, and the onset of post-traumatic epilepsy, scarcely responsive to common antiepileptic drugs. The treatment of the abscess by combined systemic and intracavitary antibiotic therapy and of the chronic seizures by progressive adjustment with new protocols of antiepileptic drugs under EEG and brain mapping revealed successful.- - - - - - - - - - ranking = 2keywords = drug (Clic here for more details about this article) |
6/43. Aneurysm expansion and retroperitoneal hematoma after thrombolysis for stent-graft limb occlusion caused by distal endograft migration.PURPOSE: To describe a complication of thrombolytic therapy used to treat graft limb occlusion precipitated by distal migration and kinking of an abdominal aortic stent-graft. CASE REPORT: A 5.5-cm abdominal aortic aneurysm (AAA) in a 66-year-old woman was treated with Vanguard bifurcated stent-graft. At the 1-year follow-up, she complained of left leg claudication. Computed tomography (CT) showed a 36% reduction in maximum AAA diameter, but the stent-graft had migrated distally approximately 5 mm, and the left graft limb was occluded. Thrombolysis was initiated, but after approximately 8 hours, abdominal pain began. Emergent CT scanning revealed rapid aneurysm expansion and a retroperitoneal hematoma. Thrombolytic treatment was stopped; transfusions and thrombogenic drugs were given to restore hemodynamic stability. The aneurysm began to decrease in size. The occluded graft limb had been reopened by the lytic therapy, uncovering a stenosis in the native artery distal to the graft limb. Stent placement restored outflow. The retroperitoneal hematoma resolved over time, and the aneurysm sac shrank to its prelytic diameter. The patient is well with a functioning endograft 18 months after the occlusion (30 months after stent-grafting). CONCLUSIONS: Caution must be taken when using thrombolysis in patients with endovascular aortic grafts because unexpected bleeding complications might arise. thrombectomy, femorofemoral bypass, or stent or stent-graft extensions might be safer alternatives for treating occluded stent-graft limbs.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
7/43. tracheoesophageal fistula in AIDS: stent versus primary repair.tracheoesophageal fistula arising secondary to mycobacterium tuberculous infection in AIDS patients is extremely rare. We describe a case with a fistula lesion that initially failed to close using a four-drug antituberculosis regimen. The original lesion closed following placement of an esophageal stent. However, the stent migrated, causing an iatrogenic tracheoesophageal fistula that needed surgical repair. tracheoesophageal fistula (TEF) is an uncommon clinical condition, most frequently arising as a sequelae to esophageal malignancy. Iatrogenic injury to the membraneous trachea secondary to cuffed endotracheal or tracheostomy tubes in the presence of an in-dwelling nasogastric tube and corrosive burns, accounts for most of the remainder of occurring fistulas. Infections such as candidiasis, syphilis, and tuberculosis are also known to cause this condition. We report stent migration with perforation and subsequent TEF formation in an hiv-positive patient who originally had stent placement for a tuberculous tracheoesophageal fistula.- - - - - - - - - - ranking = 1keywords = drug (Clic here for more details about this article) |
8/43. Closure of an iatrogenic aortocoronary arteriovenous fistula: transcatheter balloon embolization following failed coil embolization and salvage of coils that migrated into the coronary venous system.We report a 50-year-old patient with successful percutaneous closure of a large inadvertent surgical aortocoronary arteriovenous fistula (shunt flow: 1.8 L/min). With initial embolization of multiple coils, no lasting occlusion of the large fistula could be achieved. Above that, two coils migrated into the coronary venous system. Following rescue of the migrated coils through a retrograde coronary sinus approach, the fistula was occluded using a detachable balloon. Follow-up angiograms confirmed successful closure of the fistula. In contrast to coil embolization, use of a detachable balloon seems to be the appropriate technique for percutaneous closure of such fistulas.- - - - - - - - - - ranking = 41.296106928425keywords = closure (Clic here for more details about this article) |
9/43. Repeated Gunther Tulip inferior vena cava filter repositioning to prolong implantation time.A patient presented with iliofemoral deep vein thrombosis, a small pulmonary embolism, and a paradoxic embolus to the axillary artery resulting from a patent foramen ovale (PFO). As prophylaxis against further paradoxic emboli while awaiting percutaneous PFO closure, a Gunther Tulip inferior vena cava (IVC) filter was implanted. To prevent incorporation of the IVC filter into the caval wall, it was repositioned twice with use of a filter retrieval set from a transjugular approach. In this way, the implantation time of the filter was extended beyond the recommended period of 10 days. The filter was successfully retrieved 19 days later during percutaneous closure of the PFO.- - - - - - - - - - ranking = 27.530737952283keywords = closure (Clic here for more details about this article) |
10/43. A novel technique to prevent displacement of inferior vena cava filter during cardiac catheterization with subsequent transcatheter closure of a patent foramen ovale in a patient with cryptogenic shock.We describe a novel technique to prevent displacement of a previously implanted inferior vena cava filter in a patient with cryptogenic stroke who underwent transcatheter closure of a patent foramen ovale. This technique may be of use to patients with cryptogenic stroke who might benefit from transcatheter closure of their patent foramen ovale but would otherwise not be candidates for the procedure because of risk of dislodgement of previously implanted inferior vena cava filter.- - - - - - - - - - ranking = 82.592213856849keywords = closure (Clic here for more details about this article) |
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